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Mrs. Marina Deatherage
Nurse Practitioner in Lake Geneva, Wisconsin
NPI 1538706858

Marina Deatherage is a Nurse Practitioner based in Lake Geneva, WI. Marina Deatherage practices in Lake Geneva, WI. The NPI Number for Marina Deatherage is 1538706858 and holds a License No. 209020317 (Wisconsin).

The current practice location address for Marina Deatherage is 146 E Geneva Sq, Lake Geneva, WI and can be reached out via phone at 262-249-4660.

Location: 146 E Geneva Sq, Lake Geneva, WI, 53147-9694
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1538706858
Provider Name
Marina Deatherage
Credential
Provider Entity Type
Individual
Gender
Female
Address
146 E Geneva Sq, Lake Geneva, WI, 53147-9694
Phone Number
262-249-4660
Fax Number
Provider Enumeration Date
12/05/2019
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
100162164 05 WI
institution
Provider Business Practice Location Address Details
Address
146 E Geneva Sq
City
Lake Geneva
State
Wisconsin
Zip
53147-9694
Phone Number
262-249-4660
Fax Number
person
Provider Business Mailing Address Details
Address
146 E Geneva Sq
City
Lake Geneva
State
Wisconsin
Zip
53147-9694
Phone Number
262-249-4660
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
-
Taxonomy
363L00000X
License No.
10857-033 (Wisconsin)
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
person
Provider's Taxonomy Details 2
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
363LF0000X
License No.
209020317 (Illinois)
Definition
Definition to come...
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